Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Int J Gynecol Cancer. 2013 Mar;23(3):546-52. doi: 10.1097/IGC.0b013e3182842efa.
There are limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in the last 6 months of life. Patient demographics, patterns of care, and utilization of palliative medicine consultation services were evaluated.
One hundred patients who died of gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within 1 year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record, and analyses were made using Student t test and Mann-Whitney U test with SPSS software.
The mean age of patients was 60 years (range, 30-94 years). Racial/ethnic distribution was as follows: 38%, white; 34%, black; and 15%, Hispanic. Seventy-five percent of patients received chemotherapy within the last 6 months of life, and 30% received chemotherapy within the last 6 weeks of life. The median number of days hospitalized during the last 6 months of life was 24 (range, 0-183 days). During the last 6 months of life, 19% were admitted to the intensive care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardiopulmonary resuscitative efforts. Sixty-four percent had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had 14 days or more from consultation until death versus patients who had 14 days or less or no consultation, 21 (72%) versus 29 (41%), P = 0.004. Patients who were single were less likely to have a palliative medicine consultation, P = 0.005.
End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or quality of life. These pilot data suggest that factors for implementation of timely hospice referral, family support, and legacy building should include specialists trained in palliative medicine.
妇科恶性肿瘤患者的临终关怀数据有限。我们旨在生成描述妇科恶性肿瘤患者在生命的最后 6 个月内所接受的护理的初步数据。评估了患者的人口统计学特征、护理模式以及姑息医学咨询服务的利用情况。
在我们的机构数据库中确定了 100 名死于妇科恶性肿瘤的患者。仅纳入在死亡前 1 年内接受过妇科肿瘤医生治疗的患者。查阅病历以获取相关信息。从电子病历中提取数据，并使用 SPSS 软件进行学生 t 检验和曼-惠特尼 U 检验分析。
患者的平均年龄为 60 岁（范围，30-94 岁）。种族/民族分布如下：38%，白人；34%，黑人；15%，西班牙裔。75%的患者在生命的最后 6 个月内接受了化疗，30%的患者在生命的最后 6 周内接受了化疗。生命的最后 6 个月住院天数中位数为 24 天（范围，0-183 天）。生命的最后 6 个月内，19%的患者住进重症监护病房，17%的患者被插管，5%的患者进行了终末期拔管，13%的患者进行了心肺复苏抢救。64%的患者进行了家庭会议，50%的患者使用了临终关怀，49%的患者接受了姑息治疗咨询。与咨询后至死亡的时间为 14 天或以上的患者相比，咨询后至死亡的时间为 14 天或以下或未咨询的患者接受临终关怀的比例有显著差异，21（72%）比 29（41%），P=0.004。单身患者接受姑息治疗咨询的可能性较小，P=0.005。
妇科恶性肿瘤患者的临终关怀通常包括无效、激进的治疗和侵入性操作。目前尚不清楚这些措施是否有助于延长寿命或提高生活质量。这些初步数据表明，及时转介姑息治疗、家庭支持和遗产建设的实施因素应包括接受过姑息治疗培训的专家。
